Health policy

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The headquarters of the World Health Organization in Geneva, Switzerland. World Health Organisation building from west.jpg
The headquarters of the World Health Organization in Geneva, Switzerland.

Health policy can be defined as the "decisions, plans, and actions that are undertaken to achieve specific healthcare goals within a society". [1] According to the World Health Organization, an explicit health policy can achieve several things: it defines a vision for the future; it outlines priorities and the expected roles of different groups; and it builds consensus and informs people. [1]

Contents

Different approaches

Health policy often refers to the health-related content of a policy. Understood in this sense, there are many categories of health policies, including global health policy, public health policy, mental health policy, health care services policy, insurance policy, personal healthcare policy, pharmaceutical policy, and policies related to public health such as vaccination policy, tobacco control policy or breastfeeding promotion policy. Health policy may also cover topics related to healthcare delivery, for example of financing and provision, access to care, quality of care, and health equity. [ citation needed ]

Health policy also includes the governance and implementation of health-related policy, sometimes referred to as health governance, [2] health systems governance or healthcare governance. [3] Conceptual models can help show the flow from health-related policy development to health-related policy and program implementation and to health systems and health outcomes. Policy should be understood as more than a national law or health policy that supports a program or intervention. Operational policies are the rules, regulations, guidelines, and administrative norms that governments use to translate national laws and policies into programs and services. [4] The policy process encompasses decisions made at a national or decentralized level (including funding decisions) that affect whether and how services are delivered. Thus, attention must be paid to policies at multiple levels of the health system and over time to ensure sustainable scale-up. A supportive policy environment will facilitate the scale-up of health interventions. [5]

There are many aspects of politics and evidence that can influence the decision of a government, private sector business or other group to adopt a specific policy. Evidence-based policy relies on the use of science and rigorous studies such as randomized controlled trials to identify programs and practices capable of improving policy relevant outcomes. Most political debates surround personal health care policies, especially those that seek to reform healthcare delivery, and can typically be categorized as either philosophical or economic. Philosophical debates center around questions about individual rights, ethics and government authority, while economic topics include how to maximize the efficiency of health care delivery and minimize costs.[ citation needed ]

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Countries with universal health care
Countries with universal health care
Countries without universal healthcare
Countries without universal healthcare
Unknown Universal Healthcare by Country.svg
  Countries with universal health care
  Countries with universal health care
  Countries without universal healthcare
  Countries without universal healthcare
  Unknown

The modern concept of healthcare involves access to medical professionals from various fields as well as medical technology, such as medications and surgical equipment. It also involves access to the latest information and evidence from research, including medical research and health services research.[ citation needed ]

In many countries it is left to the individual to gain access to healthcare goods and services by paying for them directly as out-of-pocket expenses, and to private sector players in the medical and pharmaceutical industries to develop research. Planning and production of health human resources is distributed among labour market participants.[ citation needed ]

Other countries have an explicit policy to ensure and support access for all of its citizens, to fund health research, and to plan for adequate numbers, distribution and quality of health workers to meet healthcare goals. Many governments around the world have established universal health care, which takes the burden of healthcare expenses off of private businesses or individuals through pooling of financial risk. There are a variety of arguments for and against universal healthcare and related health policies. Healthcare is an important part of health systems and therefore it often accounts for one of the largest areas of spending for both governments and individuals all over the world.

Personal healthcare policy options

Philosophy: right to health

Many countries and jurisdictions integrate a human rights philosophy in directing their healthcare policies. The World Health Organization reports that every country in the world is party to at least one human rights treaty that addresses health-related rights, including the right to health as well as other rights that relate to conditions necessary for good health. [6] The United Nations' Universal Declaration of Human Rights (UDHR) asserts that medical care is a right of all people: [7]

In some jurisdictions and among different faith-based organizations, health policies are influenced by the perceived obligation shaped by religious beliefs to care for those in less favorable circumstances, including the sick. Other jurisdictions and non-governmental organizations draw on the principles of humanism in defining their health policies, asserting the same perceived obligation and enshrined right to health. [8] [9] In recent years, the worldwide human rights organization Amnesty International has focused on health as a human right, addressing inadequate access to HIV drugs and women's sexual and reproductive rights including wide disparities in maternal mortality within and across countries. Such increasing attention to health as a basic human right has been welcomed by the leading medical journal The Lancet . [10]

There remains considerable controversy regarding policies on who would be paying the costs of medical care for all people and under what circumstances. For example, government spending on healthcare is sometimes used as a global indicator of a government's commitment to the health of its people. [11] On the other hand, one school of thought emerging from the United States rejects the notion of health care financing through taxpayer funding as incompatible with the (considered no less important) right of the physician's professional judgment, and the related concerns that government involvement in overseeing the health of its citizens could erode the right to privacy between doctors and patients. The argument furthers that universal health insurance denies the right of individual patients to dispose of their own income as per their own will. [12] [13]

Another issue in the rights debate is governments' use of legislation to control competition among private medical insurance providers against national social insurance systems, such as the case in Canada's national health insurance program. Laissez-faire supporters argue that this erodes the cost-effectiveness of the health system, as even those who can afford to pay for private healthcare services drain resources from the public system. [14] The issue here is whether investor-owned medical insurance companies or health maintenance organizations are in a better position to act in the best interests of their customers compared to government regulation and oversight. Another claim in the United States perceives government over-regulation of the healthcare and insurance industries as the effective end of charitable home visits from doctors among the poor and elderly. [15]

Economics: healthcare financing

Public and private health expenditure by country Public and private health expenditure by country.svg
Public and private health expenditure by country

Many types of health policies exist focusing on the financing of healthcare services to spread the economic risks of ill health. These include publicly funded health care (through taxation or insurance, also known as single-payer systems), mandatory or voluntary private health insurance, and complete capitalization of personal health care services through private companies, among others. [16] [17] The debate is ongoing on which type of health financing policy results in better or worse quality of healthcare services provided, and how to ensure allocated funds are used effectively, efficiently and equitably.

There are many arguments on both sides of the issue of public versus private health financing policies:

Claims that publicly funded healthcare improves the quality and efficiency of personal health care delivery:

Claims that privately funded healthcare leads to greater quality and efficiencies in personal health care:

Other health policy areas

Health policy options extend beyond the financing and delivery of personal health care, to domains such as medical research and health workforce planning, both domestically and internationally.

Medical research policy

Medical research can be both the basis for defining evidence-based health policy, and the subject of health policy itself, particularly in terms of its sources of funding. Those in favor of government policies for publicly funded medical research posit that removing profit as a motive will increase the rate of medical innovation. [25] Those opposed argue that it will do the opposite, because removing the incentive of profit removes incentives to innovate and inhibits new technologies from being developed and utilized. [23] [26]

The existence of sound medical research does not necessarily lead to evidence-based policymaking. For example, in South Africa, whose population sets the record for HIV infections, previous government policy limiting funding and access for AIDS treatments met with strong controversy given its basis on a refusal to accept scientific evidence on the means of transmission. [27] A change of government eventually led to a change in policy, with new policies implemented for widespread access to HIV services. [28] Another issue relates to intellectual property, as illustrated by the case of Brazil, where debates have arisen over government policy authorizing the domestic manufacture of antiretroviral drugs used in the treatment of HIV/AIDS in violation of drug patents.

Health workforce policy

Some countries and jurisdictions have an explicit policy or strategy to plan for adequate numbers, distribution and quality of health workers to meet healthcare goals, such as to address physician and nursing shortages. Elsewhere, workforce planning is distributed among labour market participants as a laissez-faire approach to health policy. Evidence-based policies for workforce development are typically based on findings from health services research.

Health in foreign policy

Many governments and agencies include a health dimension in their foreign policy in order to achieve global health goals. Promoting health in lower income countries has been seen as instrumental to achieve other goals on the global agenda, including: [29]

Global health policy

Global health policy encompasses the global governance structures that create the policies underlying public health throughout the world. In addressing global health, global health policy "implies consideration of the health needs of the people of the whole planet above the concerns of particular nations." [30] Distinguished from both international health policy (agreements among sovereign states) and comparative health policy (analysis of health policy across states), global health policy institutions consist of the actors and norms that frame the global health response. [31]

See also

Related Research Articles

Health care reform is for the most part governmental policy that affects health care delivery in a given place. Health care reform typically attempts to:

A health system, health care system or healthcare system is an organization of people, institutions, and resources that delivers health care services to meet the health needs of target populations.

<span class="mw-page-title-main">Health care</span> Prevention of disease and promotion of well-being

Health care, or healthcare, is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health professionals and allied health fields. Medicine, dentistry, pharmacy, midwifery, nursing, optometry, audiology, psychology, occupational therapy, physical therapy, athletic training, and other health professions all constitute health care. The term includes work done in providing primary care, secondary care, and tertiary care, as well as in public health.

<span class="mw-page-title-main">Publicly funded health care</span> Form of health care financing

Publicly funded healthcare is a form of health care financing designed to meet the cost of all or most healthcare needs from a publicly managed fund. Usually this is under some form of democratic accountability, the right of access to which are set down in rules applying to the whole population contributing to the fund or receiving benefits from it.

<span class="mw-page-title-main">Healthcare industry</span> Economic sector focused on health

The healthcare industry is an aggregation and integration of sectors within the economic system that provides goods and services to treat patients with curative, preventive, rehabilitative, and palliative care. It encompasses the creation and commercialization of products and services conducive to the preservation and restoration of well-being. The contemporary healthcare sector comprises three fundamental facets, namely services, products, and finance. It can be further subdivided into numerous sectors and categories and relies on interdisciplinary teams of highly skilled professionals and paraprofessionals to address the healthcare requirements of both individuals and communities.

<span class="mw-page-title-main">Universal health care</span> System that grants access to healthcare to all residents or citizens of a country or region

Universal health care is a health care system in which all residents of a particular country or region are assured access to health care. It is generally organized around providing either all residents or only those who cannot afford on their own, with either health services or the means to acquire them, with the end goal of improving health outcomes.

Algeria is the largest country in Africa and is estimated to have a population of around 40 million people. Algeria has a public health care system, which is accessible and free of charge to all citizens of Algeria. The public health care system is financed by the government of Algeria. Given Algeria's young population, policy favors preventive health care and clinics over hospitals. In keeping with this policy, the government maintains an intensive immunization programme and a policy which allows Algerian citizens health care for Hospitalisations, medicines and outpatient care free to all citizens of Algeria.

A public hospital, or government hospital, is a hospital which is government owned and is fully funded by the government and operates solely off the money that is collected from taxpayers to fund healthcare initiatives. In some countries, this type of hospital provides medical care free of charge to patients, covering expenses and wages by government reimbursement.

<span class="mw-page-title-main">Healthcare in Israel</span> Overview of the health care system in Israel

Healthcare in Israel is universal and participation in a medical insurance plan is compulsory. All Israeli residents are entitled to basic health care as a fundamental right. The Israeli healthcare system is based on the National Health Insurance Law of 1995, which mandates all citizens resident in the country to join one of four official health insurance organizations, known as Kupat Holim which are run as not-for-profit organizations and are prohibited by law from denying any Israeli resident membership. Israelis can increase their medical coverage and improve their options by purchasing private health insurance. In a survey of 48 countries in 2013, Israel's health system was ranked fourth in the world in terms of efficiency, and in 2014 it ranked seventh out of 51. In 2020, Israel's health system was ranked third most efficient in the world. In 2015, Israel was ranked sixth-healthiest country in the world by Bloomberg rankings and ranked eighth in terms of life expectancy.

Healthcare in Georgia is provided by a universal health care system under which the state funds medical treatment in a mainly privatized system of medical facilities. In 2013, the enactment of a universal health care program triggered universal coverage of government-sponsored medical care of the population and improving access to health care services. Responsibility for purchasing publicly financed health services lies with the Social Service Agency (SSA).

<span class="mw-page-title-main">Healthcare in Tanzania</span>

Tanzania has a hierarchical health system which is in tandem with the political-administrative hierarchy. At the bottom, there are the dispensaries found in every village where the village leaders have a direct influence on its running. The health centers are found at ward level and the health center in charge is answerable to the ward leaders. At the district, there is a district hospital and at the regional level a regional referral hospital. The tertiary level is usually the zone hospitals and at a national level, there is the national hospital. There are also some specialized hospitals that do not fit directly into this hierarchy and therefore are directly linked to the ministry of health.

<span class="mw-page-title-main">Healthcare in Iceland</span>

Iceland has a state-centred, publicly funded universal healthcare system and health insurance that covers the whole population. The number of private providers in Iceland has increased. The healthcare system is largely paid for by taxes (84%) and to some extent by service fees (16%) and is administered by the Ministry of Health. A considerable portion of government spending is assigned to healthcare. There is almost no private health insurance in Iceland and no private hospitals. In very limited cases, access to a private provider can be reimbursement for services provided that the conditions are met.

Healthcare in the United States is largely provided by private sector healthcare facilities, and paid for by a combination of public programs, private insurance, and out-of-pocket payments. The U.S. is the only developed country without a system of universal healthcare, and a significant proportion of its population lacks health insurance.

Examples of health care systems of the world, sorted by continent, are as follows.

Healthcare in the State of Palestine refers to the governmental and private healthcare providers to which residents in the claimed territory have access. Since 1967, there have been improvements in the access to healthcare and the overall general health conditions for residents. Advances in training, increased access to state-of-the-art medical technology, and various governmental provisions have allowed per-capita funding to increase, and therefore the overall health of residents in the region to increase. Additionally, the enhanced access to and funding from international organizations like the World Health Organization, the United Nations, the Palestinian Ministry of Health, and the World Bank Education and Health Rehabilitation Project have contributed to the current state of affairs within the healthcare segment of the Palestinian territories. However, while many efforts at enhancing the state of health affairs within the Palestinian territories have shown improvement, there are still efforts to be made. Continued efforts to recognize and address the geopolitical barriers will be necessary in order to continue to have significant success in this field. Finally, addressing demographic trends within the region, like differing pregnancy rates and mortality rates, will be necessary to enhance the state of health affairs that the Palestinian territories face. This article addresses each of these issues in more explanatory detail, giving an overview of the major legal and ethical developments in healthcare within the Palestinian territories, and discussing further obstacles that the region faces due to infrastructural and political barriers.

<span class="mw-page-title-main">Healthcare in India</span> Overview of the health care system in India

India has a multi-payer universal health care model that is paid for by a combination of public and private health insurance funds along with the element of almost entirely tax-funded public hospitals. The public hospital system is essentially free for all Indian residents except for small, often symbolic co-payments in some services.

<span class="mw-page-title-main">Healthcare in Belize</span>

Healthcare in Belize is provided through both public and private healthcare systems. The Ministry of Health (MoH) is the government agency responsible for overseeing the entire health sector and is also the largest provider of public health services in Belize. The MoH offers affordable care to a majority of Belizeans with a strong focus on providing quality healthcare through a range of public programs and institutions.

<span class="mw-page-title-main">Healthcare in Egypt</span>

The Egyptian healthcare system is pluralistic, comprising a variety of healthcare providers from the public as well as the private sector. The government ensures basic universal health coverage, although private services are also available for those with the ability to pay. Due to social and economic pressures, Egypt's healthcare system is subject to many challenges. However, several recent efforts have been directed towards enhancing the system.

<span class="mw-page-title-main">PharmAccess Foundation</span> Non-profit organization

PharmAccess Foundation is a part of the PharmAccess Group. PharmAccess is an international non-profit organization with a digital agenda dedicated to connecting more people in sub-Saharan Africa to better healthcare. By making use of public-private partnerships, they leverage donor contributions, which they believe will pave the way for private investments hereby contributing to healthier populations and social and economic development. Currently PharmAccess employs a multidisciplinary team of professionals in Tanzania, Kenya, Nigeria, Ghana and the Netherlands.

References

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